Higher gross, lower cost

In my last column, I wrote about the importance of adding value to your practice by adding new techniques, new technologies, and new procedures.

Aug 1st, 2006

In my last column, I wrote about the importance of adding value to your practice by adding new techniques, new technologies, and new procedures. I also outlined the steps involved in permanently integrating these procedures into your practice.

This month, I will describe the fastest way to add at least $100,000 to your gross production while adding only minimal cost. When you look for the biggest impact on your practice, you start from opposite ends of your procedure mix. The opposite ends are high-dollar procedures that a few patients want or low-dollar procedures that everyone needs.

The first value-added procedure that we need to talk about became apparent when I was covering emergencies for a friend last week. This friend is one of the top prosthodontists in our area. I saw three emergency patients who presented with fractured molar cusps due to interproximal decay. All three had been seen in the last six months. This experience left me questioning whether my friend was taking enough X-rays, and was effective at communicating the needed treatment. The full-mouth series is the classic example of a low-dollar procedure that almost everyone needs and very few patients get. In our practice, every patient is scheduled for a full-mouth series of X-rays every three to five years. If you have 1,000 patients who are past due for their full-mouth series, this works out to an immediate $100,000 hit to your practice. If your practice does not take a full-mouth X-ray series on virtually every patient, it is because of a failure in one of the four steps to adding value to a practice. These steps are 1) failure in vision, 2) failure of tools, 3) failure in mechanics, or 4) failure in accountability.

The vision in this case is not about seeing yourself on a Caribbean beach with an extra week of vacation because you have added $100,000 to your gross production. When you make a change to your practice, the vision must always be about how your patients and staff will benefit. In this case, the vision obviously involves earlier and better detection of dental disease. With the right tools, your vision also could be about reducing radiation exposure.

The first tool you need is always the excellent set of verbal skills your staff will need to master to generate patient compliance. Believe me when I tell you that your staff will be very effective at implementing the periodic full-mouth series. When you look at other tools for X-rays, you obviously need processing, chemicals, and film. This is where you can further benefit your patients, as well as yourself, by going digital. In a conventional system, a series of 1,000 full-mouth X-rays is equal to 18,000 individual films. The generally accepted cost of a dental X-ray is a little more than a dollar per film. This $18,000 expense would pay for a digital radiography system, while increasing your gross production by $100,000.

The next tool you need is a digital radiography system. The mechanics, in this case, involve training. Everyone must train their verbal skills by role-playing. If you are going digital, everyone requires training on the new system. The real question is who will actually take these films and what changes will be required in your scheduling to take 18,000 films without making your other patients wait.

Accountability is always about tracking your results. If your goal is 1,000 full-mouth X-ray series in the next year, this can be broken down monthly or even weekly. Create tracking forms and ask for a summary report from staff at least every week. If the results are not on target, find out why and then either improve your training or work on motivation. If you truly follow the four steps, you will most likely be successful. Find a way to celebrate every success in your practice.

If you are moving into a very high-quality practice, there may not be 1,000 patients past due for full-mouth X-rays. Judging from the new patients who come to my practice, less than half of all offices are regularly completing full-mouth series. If you are looking at a practice purchase, this should definitely be a part of your chart-review process. How many patients have current X-rays?

There are two extremely valuable concepts you should take from this article. The first concept is that implementing any new procedure or technology into your practice will be successful if you follow the four steps of vision, tools, mechanics, and accountability. The second concept is about replacement technologies. New equipment purchases that directly replace an existing technology must increase services to be truly profitable.

Dr. Michael Gradeless, a 1980 graduate of Indiana University, practices preventive dentistry in Indianapolis with an emphasis on cosmetics and implants. He is an adjunct faculty member at Indiana University, where he teaches the Pride Institute university curriculum of dental management. He also is the editor for the Indiana Dental Association. Contact him at (317) 841-3130 or e-mail to drmike44@aol.com.